THIS IS A FILLABLE FORM
FOR THE STUDENT. Type
PART A ONLY; then print out
for your advisor.
A
THE UNIVERSITY OF SOUTHERN MISSISSIPPI
PETITION FOR PROBATION CONTINUED CLEARANCE
Clearance to
Year
Student's Name
ID
enroll for Term
Email
Cell Phone
College
Desired Major
(if applicable)
1. Please type a statement below supporting your request for enrollment. (Max length 255 characters.) Attach a typed statement if needed.
2. Include an UNOFFICIAL academic transcript from SOAR or from the Registrar's Office.
3. Have your advisor, department chair, and dean review your petition to determine the appropriate course of action.
B
Term for cleared petition: (TO BE COMPLETED IN CONSULTATION WITH STUDENT'S ADVISOR)
Student agrees to follow the terms of this contract:
A. The student will enroll in the following courses. (Any changes to advisor-approved schedule should be made in consultation with
academic advisor and with written permission of director/chair.)
B. The student must
( ) earn a minimum TERM grade point average of for the term.
( ) bring the cumulative USM GPA above 2.00 by end of current semester.
C. Additional conditions:
Advisor
Date
Student met
previous contract.
Student did not meet
previous contract.
Enrollment Decision: Cleared for enrollment
Denied enrollment
Term
COMMENTS:
Dean or Designee of the College Date
The student's probation continued service indicator must be removed by the College Dean/Dean Designee before the student is
able to make any course adjustments.
NOTE: The clearance form can only be for the ONE term specified for CONTRACT GPA comparison.
PROBATION CONTINUED CLEARANCE
Revised 2/2013
Appt
Date/Time
Student
Director
TO BE COMPLETED BY COLLEGE DEAN:
Date
Recommendation:
Approve
Deny
Print Form
Current Major:
C
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